Volume 185 - Issue 4
A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice
Author: Allan D Spigelman
Med J Aust 2006; 185 (4): 237-239. || doi: 10.5694/j.1326-5377.2006.tb00543.x
Published online: 21 August 2006
Published online: 21 August 2006
To the Editor: Australia’s imminent bowel cancer screening program will revolve around the general practitioner,1-3 whereas, in the United Kingdom, the GP will have virtually nothing to do with the national screening program now underway.4 It is curious that two programs with the same evidence base regarding effectiveness should be so fundamentally different. One explanation could be the differing health care systems in each nation. However, they are more alike than not, so the true explanation for the Australian methodology could rest with the outcome of the Australian pilot studies.
If that is the case, then perhaps one should be both alert and alarmed. Given the inequity in access to GPs in Australia, it is not surprising that the Final Evaluation Report5 of the pilot national screening program stated that:
Some GPs interviewed in Woolcott’s Qualitative Research focus groups . . . expressed concern over access to FOBTs [Faecal Occult Blood Tests] for people without a fixed address. It was mentioned that this group, particularly Aboriginal and Torres Strait Islander people and people in low socioeconomic groups, particularly homeless people, did not receive invitations to participate in the Pilot. Some GPs commented that the information packs, in both English and the translated versions, were too complicated for people with low literacy and those from culturally and linguistically diverse backgrounds.5
The same report noted that 38% of people overall (men, 42%; women, 34%) and 52% of non-English speakers did not visit their GP after a positive FOBT. Nevertheless, the report favours the continued central role of the GP.5
This is not the case in the UK screening program, which has a more direct approach, with program hubs and associated screening centres — all with defined accountabilities. The Australian approach is to simply add to the workload of GPs — a more pragmatic approach in the short term, but less imaginative. Our program will undoubtedly be a step forward in colorectal cancer prevention. The question is how large that step will be. Reliance on the existing system threatens to reinforce existing health care inequities.
References
- National Health and Medical Research Council. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Canberra: NHMRC, 2005.
- Salkeld GP, Young JM, Solomon MJ. Consumer choice and the National Bowel Cancer Screening Program [editorial]. Med J Aust 2006; 184: 541-542. 0_pgfId-1122556
- The Multicentre Australian Colorectal-neoplasia Screening (MACS) Group. A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice. Med J Aust 2006; 184: 546-550. 0_i1091792
- National Health Service. NHS Bowel Cancer Screening Programme [website]. http://cancerscreening.org.uk/bowel/ (accessed Jul 2006).
- Bowel Cancer Screening Pilot Monitoring and Evaluation Steering Committee. Australia’s bowel cancer screening pilot and beyond: final evaluation report. Canberra: Australian Government Department of Health and Ageing, 2005. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/eval-oct05-cnt/$File/eval-oct05.pdf (accessed Aug 2006).